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Fractional laser therapy improves scar scores and collagen regeneration more than microneedling for dermal lesionsFractional laser therapy improves scar appearance more than microneedling

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Key Takeaway
Consider fractional laser therapy over microneedling for superior scar scores and collagen regeneration in dermal lesions.

This meta-analysis evaluated the efficacy of fractional laser therapy compared to microneedling for patients with non-acne scars and scar-like dermal fibrotic lesions. The primary outcome of scar scores showed a statistically significant advantage for fractional laser therapy over microneedling (SMD = -0.99; 95% CI [-1.83, -0.15], P = 0.02). Additionally, fractional laser therapy showed a statistically significant advantage in collagen fiber regeneration (SMD = -2.14; 95% CI [-3.57, -0.72], P = 0.03).

No statistically significant differences were observed between the two interventions regarding elastic fiber improvement, epidermal thickness, or the incidence of adverse events. These findings suggest that fractional laser therapy may provide superior improvement in overall scar severity and collagen regeneration compared to microneedling for these specific conditions.

The authors note several limitations, including substantial heterogeneity, limited sample sizes, and potential reporting bias. Due to these factors, the clinical certainty of these findings is limited. Practitioners should interpret the evidence cautiously when choosing between these modalities for treating non-acne scars and dermal fibrotic lesions.

Living with scars can be a constant reminder of past injuries or skin conditions. For people dealing with non-acne scars or firm, scar-like skin lesions, finding the right treatment is a major concern. New data comparing two common methods, fractional laser therapy and microneedling, offers a clearer look at which option might work better for skin texture.

The analysis found that fractional laser therapy led to significantly better scar scores than microneedling. It also showed a significant advantage in regenerating collagen fibers, which are the proteins that give skin its structure. While both treatments were compared, the study did not find a significant difference between the two when it came to improving elastic fibers or the thickness of the top layer of skin.

It is important to note that the results should be viewed with some caution. The researchers noted that the data came from small sample sizes and showed a lot of variety between different studies. While the laser showed better results for collagen and overall scar scores, both methods were found to have similar rates of side effects. Talk to a doctor to see which option fits your specific skin needs.

What this means for you:
Fractional laser therapy shows better results for scar severity and collagen growth than microneedling.

Common questions

Is fractional laser therapy more effective than microneedling for scars?

Yes, the study found a statistically significant advantage for fractional laser therapy over microneedling when measuring scar scores. It also showed significantly better results for collagen fiber regeneration. However, there was no significant difference between the two methods regarding elastic fiber improvement or epidermal thickness.

Are there more side effects with laser therapy compared to microneedling?

No, the study found no statistically significant difference between fractional laser therapy and microneedling regarding adverse events. Both treatments were reported to have similar safety profiles in terms of the types of side effects patients experienced.

How certain are these results for scar treatment?

The findings should be interpreted cautiously. The researchers noted that the evidence is limited by small sample sizes, a lot of variation between studies, and possible reporting bias. You should discuss these options with a medical professional to determine the best path for your specific condition.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Scarring caused by trauma, burns, surgery, and other dermal fibrotic conditions can lead to functional limitation and cosmetic distress. The comparative effectiveness of fractional laser therapy and microneedling for non-acne scars remains uncertain. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials comparing fractional laser therapy with microneedling for non-acne scars and scar-like dermal fibrotic lesions. Following a PROSPERO-registered protocol and PRISMA guidelines, we searched PubMed, EMBASE, Web of Science, Cochrane Library, and CNKI from inception to May 2026 without language restrictions. Parallel-group and split-body randomized trials were eligible. Random-effects models were used to calculate standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. RESULTS: Nine randomized controlled trials were included. Fractional laser therapy showed a statistically significant advantage over microneedling in scar scores (SMD = -0.99, 95% CI [-1.83, -0.15], P = 0.02) and collagen fiber regeneration (SMD = -2.14, 95% CI [-3.57, -0.72], P = 0.03). No statistically significant differences were found between the two interventions for elastic fiber improvement, epidermal thickness, or adverse events. Subgroup analyses did not show clear or consistent significant differences according to laser type, including comparisons between traditional and non-traditional fractional lasers and between CO₂ and non-CO₂ fractional laser systems. Substantial heterogeneity was observed across several outcomes, indicating considerable between-study variability. CONCLUSION: Based on currently available randomized evidence, fractional laser therapy may provide superior improvement in overall scar severity and collagen fiber regeneration compared with microneedling for non-acne scars and scar-like dermal fibrotic lesions. However, no clear differences were observed for elastic fiber improvement, epidermal thickness, or adverse-event incidence. Given the substantial heterogeneity, limited sample sizes, and possible reporting bias, these findings should be interpreted cautiously. Further large, standardized trials with longer follow-up are needed.
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